How Exercise Intensity Shapes Longevity, Heart Health, And Metabolic Resilience

A minute that leaves you breathless can rival eight minutes of comfortable effort. That’s the eye-opening takeaway we unpack as we dive into fresh UK Biobank data showing how vigorous activity dramatically outperforms moderate and light movement for reducing all-cause mortality, cardiovascular events, diabetes, and even cancer risk. We strip away jargon and use the talk test—can you sing, speak, or barely get a sentence out?—so anyone can gauge intensity without a lab or a smartwatch.

We explore why intensity pays off under the hood: stronger left ventricular function, bigger stroke volume, better oxygen delivery, improved lactate recycling, greater capillary and mitochondrial density, and faster glycogen turnover. Then we get practical. No fancy gear required—try telephone-pole intervals on a walk, short hill surges, a flight of stairs at speed, or breathless bursts during yardwork and shoveling. Keep light movement threaded through your day to counter the stress signals of sitting, but add slim, safe slices of intensity to unlock outsized benefits when time is tight.

We also lay out a sane progression. Find a steady state before nudging harder, start with tiny intervals, and build toward an 80 percent moderate base with 10 to 20 percent vigorous effort. Fold in resistance training to protect muscle, strength, and glucose control. The goal isn’t punishment; it’s leverage—using a few honest minutes to gain more health per unit of time. If you’ve ever wondered how to make movement matter more, this conversation offers a clear path you can start today. If it helps, share it with a friend, subscribe for more science-backed self-care, and leave a review to tell us your first vigorous minute.

For video, PowerPoint slide deck and reference studies go to www.thehealthedgepodcast.com

Transcript

Setting The Exercise Question

SPEAKER_00 0:00

Welcome to the Health Edge, translating the science of self-care. I am Mark Pettis. Glad to be with you and with my friend colleague, Dr. John Bagnulo. John, good morning. Hey, good morning, Mark. Great to see you, man. Great to see you, as always. We looked at a paper recently, John, that uh I think will be fun to share with our listeners. And it's a study that I know many people in the health podcasting world have been looking at that attempts to compare the health benefits of light versus moderate versus vigorous physical activity. And this is a paper that came out of the UK from the UK Biobank, right, where they look at thousands of people, kind of like our Enhanes database here in America, and came up with some really interesting um equivalencies, if you will, of how a minute of vigorous activity uh compares to moderate to light. And um historically, uh, at least in my mind, those relationships have usually been characterized, you know, one minute of vigorous activity is equal to maybe two minutes of more moderate activity. And, you know, should we be pushing hard? Should, you know, should we be suggesting that lighter activity has less value? Uh and it for a lot of people that I work with, there's just a lot of confusion about exercise and activity levels. And, you know, if I can't sprint, uh does that mean I can't do anything to, you know, to improve my health trajectory? And so this was a very good uh study that um um looked at this in a more quantifiable way. And I thought it would be a good basis, John, for you and I to review a little bit about the current guidelines because they're often talked about how many minutes per week of light or moderate or vigorous. Um but at the end of the day, you know, where does that come from and just how powerful are those interventions? And we'll try to add a little clarity to that uh in this discussion.

Light vs Moderate vs Vigorous Defined

SPEAKER_01 2:30

Yeah, yeah, I think it's a great segue into the kind of the more general topic about what type of adaptations does, you know, does the cardiovascular and other areas of our body what type of adaptations result from the different levels of intensity? Um, because I think, you know, at the end of the day, you and I always talk about positive stress, you know, versus stress overload, right? In anything, whether that's psychological or physical. And you know, I think that this really gives us a better understanding of how those adaptations and those responses take place to different intensities, because that's what we're trying to do when we exercise. We're trying to create adaptations that provide a better quality of health and longevity and you know, really make the aging process uh, you know, much better, a much better process and experience. So I think it's great. It's a it's a great lead into that. And to your point, there I there is a lot of confusion about, well, just move. We you know, we always hear that. Like just move. Um, you know, it doesn't matter what you're doing. And I do think there is still a lot of value to that. Like it's better to move than to sit. So, you know, but then at the end of the day, like if someone only has so much time as the the way they perceive it, they only have so much time in the day to exercise that they can commit to it, you know, are they gonna get more value uh you know from really going all out? You know, I think this would this would suggest yes, but we can dive into it now.

SPEAKER_00 3:55

Great, great Johns. We like to say, right, motion is the lotion. Yeah. And uh I and as I think we have known for for a long time historically, there is a dose response. Uh and and hopefully people can um feel more hopeful about tailoring whatever they're capable of into their lifestyles as at least an understanding that they're doing something good for themselves, even if it's not sprinting uh or you know, in ultramarathons. Uh, and and as we touched on a little bit in our last podcast, there probably is a post-peak level of activity that for some can can have some negative uh impacts longer term on cardiac function and um inflammation and things like that. So um I've got a few slides here that I'll pull up, John, just really more just to sort of set the context for the study and to just help uh our listeners understand these definitions. Um they are widely accepted. And uh uh definitely, uh no matter which consensus you're looking at, they will they will be quite similar.

Why Movement Intensity Matters

SPEAKER_01 5:13

And what I like about this, Mark, and I again thank you for for these slides. I think these are incredibly helpful to our listeners. I what I really like is that you know, you use and and the authors of this study, but you and for me forming these slides use you know, like perceived exertion through like breath. Can you talk? Because so many of the papers uh before this use a percentage of VO2 max, and that's really hard for people to understand. Yes, and to try to place themselves in one of those categories, like 90% of VO2 max. You know, I think for for many people, they don't, you know, it's hard. It's hard to determine like what percentage of that they're at. Um, you know, and even heart rates can be difficult at times. So I really like the way that you know the vigorous, moderate, and light is determined by like what can you do in terms of a conversation or singing or things like that.

SPEAKER_00 6:06

Yeah, thank you for that, John. I agree. I it unless somebody really is sort of technically uh proficient, really likes the science, um, you know, you can quickly lose people when you start talking about MVO2. And and even um while heart rate now is so readily measured, uh I I do think it it's still a little bit confusing when people talk about 60% max heart rate, 80% max heart rate, you know.

SPEAKER_01 6:38

Yeah, and Mark, there's a lot of flaws with the max heart rate equation. You know, the the whole minus your age and things like that. There's there are a lot of flaws with that equation that a lot of people still use to determine their max heart rate. Um, and I've heard some interesting stories about how that equation was developed, and there's not as much science behind that. It's sort of like drink eight, eight-ounce glasses of water a day. You know, there's it's it's kind of like a it's a fuzzy, it's a fuzzy background to that. So that's why I try to also stay away from the max heart rate equation. Um, but 220 minus your age for our listeners.

SPEAKER_00 7:16

Yeah, exactly. And this this is uh um obviously a gradient. Uh and I, you know, the talk test, I apply this myself. Yeah, absolutely. Elliptical, and uh, you know, if if I can sing the tune that's playing on my um my uh iPhone, uh you know, I might push a little harder. Uh and so these are these are nice subjective, uh and it gives people just more awareness, I think, of of how hard they're breathing and and how um uh vigorous their their uh activity is in that particular moment.

SPEAKER_01 7:53

So one thing I'll add to this that a couple exercise physiologists I know well and I talk to have said that for people that aren't talking or singing, but let's say they're watching a show on the treadmill. Um I've heard this from multiple sources that if you can follow the show and enjoy the show to its fullest extent, you're probably in the light to moderate range. If you're in the vigorous range, you're probably not catching everything that's being said in the show and you're not enjoying it very much.

SPEAKER_00 8:26

That's great.

SPEAKER_01 8:27

But yeah, yeah.

The Talk Test Over Tech Metrics

SPEAKER_00 8:28

And that for those for those who are who can't see this slide, and we'll put these up on our website, the healthedgepodcast.com, you know, light activity. You know, you could talk, you could sing easily. And to the point you just made, Sean, it it would not be unlike sitting. Uh but uh the effort here is light. And this might include, you know, casual walking, cooking, light chores, you know, stretching, just to use some examples, where moderate activity, right? You can talk, but not sing the words to a song. Um certainly people will notice more effort, harder breathing. Uh, if they check their pulse or have a heart rate device, certainly their heart rate will be higher. Uh and this would be activities like brisk walking, um, you know, a 15-minute mile, for example, uh, light cycling, you know, maybe playing doubles and tennis, raking, you know, just to give a few examples, and then vigorous activity where uh, you know, you're you're gonna be uh a bit more breathless, and it's gonna be hard to put a sentence together, hard, if not impossible, to be singing a song. Certainly you're not gonna be following the show that you're watching very in much detail. Uh and then, of course, the you know, the perception of that is that you're gonna be breathing rapidly, uh, usually we'll be sweating, uh, and so running, jogging, swimming, hiking uphill, you know, whatever that activity is, that would be the talk and the perceived exertion uh of that. So that I know a lot of our listeners know this, but it it helps to just start with some definitions and how we frame these categories. Uh and and again, this is these have been recommendations for for some time now, but um, from the Heart Association, uh, getting at least 150 minutes per week of moderate to intense, we would call that vigorous aerobic activity, uh, or 75 minutes per week of vigorous. So again, it's that two to one ratio, where there the suggestion here is that one minute of vigorous activity would be equal to about two minutes of moderate intensity. And uh if over the course of the week you're clocking 150 minutes at moderate, 75 uh of vigorous. That this would be sort of the floor. This is this is where your your uh higher might be better, um, but but this would be a good weekly target. Uh and then importantly, uh not the complete focus of of what we're talking about today, but you and I often talk about the importance of resistance activity. And um resistance activity obviously is essential for muscle mass, lean body mass, metabolic health, right, strength, power, um, endurance. Uh and one can get their heart rate up and and move more air through their lungs with um resistance activity. And so there are there are ways that one can sort of combine the two, but generally they're thought of as sort of separate categories of physical activity. And as we all know, sitting is just not very health promoting. And um uh and and a lot of research is now consistent with that. Um, self-evident is that would be, uh, and we know that even light activity can um offset uh prolonged sedentary states from a health perspective. So more is better, whether that's the the area under the curve time-wise on any given day or week, uh, but certainly the level of intensity, uh, the higher one goes up that gradient, um, the more health promoting they're likely to see their outcomes. It's pretty self-evident, John. Wouldn't you say?

Guidelines And The Two To One Myth

SPEAKER_01 12:38

Oh, yeah. Yeah. I mean, this is, you know, I think this is stuff that our listeners and you know really fully appreciate that, you know, we're just a very sedentary population, and the goal is to be moving more, sitting less. And, you know, I think what what's interesting, and we'll get into it here um with these results, but it's you know, you've got um you've got a lot of things happening in the body when we sit that are associated, believe it or not, with a stressful situation. Um you know, I'm evolutionarily, if we looked at it, our the only time our ancestors would have sat in one place for a long time is if things were really bad outside of the cave, right? And I think that what's fascinating about that is that you know, that situation, you know, 50, 100,000, 200,000 years ago, now the body misinterprets that. When we sit four or five hours at a desk, you know, the body starts to have that same type of response, right? With everything blood sugar preservation, cortisol. You, you know, again, you can speak to it more eloquently than I can. But so it's like you got to try to stay out of that negative stress state sitting in one place and just move. If you just move lightly, like again, we're gonna get into that. And this study would say, well, there aren't as many benefits to that type of movement, but it's better to be moving throughout the day with no prescribed exercise than to sit for seven or eight hours at a desk and maybe get 30 minutes of moderate to light or whatever. So I, you know, I think that's where it gets really interesting, is when you start to have that context of all of the changes in the body when we sit for prolonged periods of time. You know, again, there's there's just those associations that we're in a place of danger, so to speak, because that's where our ancestors would have been. Um, it's it's really interesting.

Sedentary Stress And Evolution

SPEAKER_00 14:52

That is a really great point, John. And I uh love that um that evolutionary biologic lens that you know, which we apply so much of the research and our experiences of of life into uh modern states of prolonged uh sitting, sedentary states, is not a normal or natural human condition. And and so I love that that that context because it most people who are at their computer eight hours a day aren't going to perceive that they're that they're creating a stress response. Uh uh and and even though it's 2025, our highly evolved brains will, right, they they don't know that you're sitting in front of a computer. You could be out in the African savanna with an injured leg, uh, with a serious infection, uh, and and that's a very different biologic response. And so when we look at that research of how prolonged sitting or sedentary states is um uh has adverse health outcomes, it's it's it's a risk, right? This is not an innocuous, well, I'm just sitting. It's harm. Uh, you know, you are harming yourself. And and that context is so interesting because we forget where we've come from, right? And when you look at when you look at the Okinawan, when you look at some of these more ancestral ways of life, they have periods where they're sitting, you know, and resting in peak sun, they're in the shade. Um, but for the most part, uh they're moving regularly with periodic sprints, uh, and and you know, they're not wearing accelerometers, they're not wearing smartwatches, they're not on treadmills, they don't have gyms. Uh the Hansa don't use gym memberships to promote their health, right? They this is just the evolved way to be uh engaging the environments that you're in. And it so it really isn't rocket science at the end of the day, but it helps to sort of I love that context, John. Thank you. Yeah. Let me get my uh slides back up here. Um and and so uh you had shared this study this morning, John, with me. This was the uh one of the more recent studies from the Heart Association in circulation that was the basis upon these recommendations of 150 minutes a week, um moderate, 75, you know, for vigorous, and um some of the data that formed the basis of that in terms of health benefit. And and it is, you know, I do think that with um for those that wear accelerometers, um, you know, there are many forms of movement that um we might not necessarily see as uh exercise, but you know, when you start looking at um you know, whether it's uh yard work, you know, doing uh aerobics, you know, some some forms of yoga, uh, you know, the vinyasa, power yoga, you know, playing tennis, uh, you know, these all really add up over the course of one's day, over the course of one's week in terms of of just moving and moving in in more than one sort of plane, right? You're you're moving through your three-dimensional environment, arms, legs, um, and not static. Uh, and and so there are so many ways to do that without without being in a treadmill or or just pounding yourself or feeling like you have to pound yourself. And of course, uh, you know, as we talked about some of those stratifications of activity level, uh certainly when you get into vigorous uh physical activity where you're becoming breathless and you're getting your heart rate up and moving much higher volumes of air through your lungs, uh, you know, obviously that's going to require whether that's you know, running, swimming, you know, dancing, you know, biking, you know, and even things that that we did as kids all the time, right? Jumping rope, yeah, um, playing, um, uh, you know, heavier yard work, things like that. So uh I so one message here is that you know, this doesn't have to be the typical sort of gym uh like activity. Um there are many ways that one can um, you know, I'm sort of in my semi retired state now, John. I do a lot more housework uh and yard work. And you know, even even on our snowy mornings when I'm out shoveling. I now see that as an invitation. Um, though it's a pain in the neck being out at in frigid weather, uh it it I see it as a gift. It's like, wow, you know, I can really get my heart work uh heart rate up and I'm and I'm and I'm breathing hard out here, shoveling on outside.

Everyday Movement As Training

SPEAKER_01 20:19

Uh total body, total body exercise. It's functional. Yeah.

SPEAKER_00 20:25

Yes. And and so uh it it for me personally, it's transformed uh uh sort of the mindful way in which I will engage activity, vacuuming in the house. Um, you know, I uh going up the stairs, up you know, instead of just slowly walking upstairs, you know, I'll jog up our little flight of stairs to the upstairs bedroom, uh, you know, down into the basement. And and so it there are so many ways that one can really uh embrace and and be mindful that um a lot of the things that that might have kind of a negative connotation attached to it can really be seen as an opportunity.

Interval Training Made Simple

Wearables, Accelerometers, And Data

SPEAKER_01 21:10

That's it. That's the key to life, in my opinion. See things that you might otherwise look at as a as a chore, um, as you know, something that's tedious, something that you know might have some discomfort, but always try to see those as opportunities because you know we always have a choice, right? That's one of my favorite, one of my favorite Buddhist uh philosophies. We always have a choice. Yes, and I think it's always good to see things if we can take that choice as you know, it's an opportunity. And and to your point, like look, the weather, I mean, here in New Hampshire, I mean, I would say at times it's horrendous, right? And I again I I try to embrace it, but it's you know, it's cold for several months, and the especially right now, here in December, um, there's very little light, but I still try to get outside. Um, you know, to try to get outside, I try to embrace it. I try to look at it as okay, I'm gonna get outside, I'm gonna have cold exposure in my face. So hopefully that thermogenesis is gonna help me in one way or another as an adaptation, right? I'm gonna get PAR activity going, maybe activate some brown adipose tissue. Then I say to myself, you know, I live here next to uh an amazing uh big preserve of land, recreation area. I'm gonna get out and I'm gonna go up these hills, you know, as fast as I can, and I'm gonna recover on my downhills, and I'm gonna just integrate some interval training because that's something that I think our listeners um could really benefit from understanding that concept of interval training. We hear about it, and it sounds technical. It sounds like you need a watch, or and I don't think you really do. And I think it really embodies so much of what you've covered, Mark, so far this morning, which is you know, when you are in light and moderate intensity and you can breathe easy, your body is still demanding oxygen, right? And your mitochondria are using, they're burning fat. And I and I I can't remember who said it. You would probably know, Mark, but someone said you could you could really predict all cause mortality rates for any population based on how much fat they burn over the course of their life. Right? I try to forget who said that, but um, they're one of the more contemporary researchers in the area of of mitochondrial health and yeah. And so what we're doing when we exercise or we're active is we're asking for more oxygen delivery. And because of that, whether it's light or moderate, whether it's a huge amount of time under the curve or it's really intense, the body has to adapt to that. And and all the different adaptations that take place meet the intensity or the criteria of that situation. So, in interval training, one thing we learned, you know, I learned in exercise physiology, I was fortunate enough to minor in that in both of my graduate programs, is that you have like four or five different adaptations that the cardiovascular system and cellular physiology are stimulated for with different scenarios. So when you have really high intensity training, which in an interval type training would be maybe 10 to 30 percent of your time, if you go out for a walk and every, let's say every 10 telephone poles, if you're walking on a highway or walking on a road with telephone poles, you know, if every one, if or you could go two telephone poles, you could run, you know, which is roughly 200 feet. If you ran for 200 feet and then you recovered with brisk walking for the next 800, like that's interval training. And you're looking at, you know, probably it's gonna end up being somewhere around 10 to 20 percent of your total time is at a higher intensity, and 80% would be at a moderate intensity. Well, in those high intensity windows, you have more stress on your left ventricle, right? Because it's working harder, it's trying to push more blood, and there's some real significant benefits with respect to left ventricular function and the strength of those contractions. And you could even say that there's some enlargement, right? You're gonna get greater stroke volume if you do this for six to eight months. I mean, that's what a lot of the research has shown as one of the biggest adaptations cardiovascular-wise, is you get this improved ventricular function and more stroke volume when you have interval training in place and you have that high intensity component. So that's huge. But then at those moderate intensities, when you back off, you train your body to metabolize lactic acid. So the body starts developing these lactic acid, uh, hydrogenase, dehydrogenase enzymes that you have different isomers, and there's LDH, you know, one through like five or six, and these different molecules have greater affinities for lactic acid based on how you've trained. And if you can train your body to catabolize and use lactic acid as a fuel instead of something that's debilitating and really really uncomfortable when it accumulates, that again is another great adaptation that takes place when you weave in some higher intensity windows with lower intensity or moderate intensity windows. So, and then you've got the whole thing about mitochondrial density, mitochondrial density as well as capillary density and the working muscles. Those take place at all levels of intensity. But there might be an argument for like, you know, that 80% of time when you're at a moderate intensity, when you go for a walk or a run or you're on a bike or whatever it is you're doing, you might be building more capillary density, which is great, right? Because that prevents muscle atrophy and that prevents just more functional muscles. It makes you better at burning fat at any given intensity. So there's just so many upsides to each of these components. And I think it's important to, like you and I always talk about, Mark, with like, you know, fasting once in a while or going ketogenic for a week, you know, whether it's once a month or every three months. You know what you do? You maintain metabolic flexibility. And I think that's what different intensities of exercise offer us as well. I think it's just metabolic flexibility. And you need to be able to adjust to that high-intensity window, but you also need to move for you know extended periods of time during the day so that you have all of your different pathways as options, right? Physiologically for you. And I, you know, that's the way I try to look at exercise is I just want to be as metabolically flexible as possible. I want to be able to burn glycogen when I need to because you know that's going to be at the highest intensity. And there's a lot of upside to burning through your glycogen stores and what that offers you for you know days after that. And um, yeah, so I know that was I got really long-winded there, but I love this, these papers because it shows that look, if you only got a limited amount of time during the day, that you're gonna say, this is prescribed exercise. I'm gonna go out whether I go to the gym or I go to the woods or I go to the park. I gotta, you know, you gotta have some discomfort there, at least with your your state of breathless, right? You're breathless for a period of time because you're placing a very favorable stressor on your cardiovascular, your pulmonary system to deliver more oxygen. And I think you should embrace some of that. Um, but then to this at the same time, like don't look at the rest of the day as a time when you should just sit, you know, try to move lightly. Whether you have a walking desk, whether you get on the treadmill when you want to do some work that requires, you know, you know, some ability to focus and you can't really go all out, but you're gonna be moving. And I think the combination of these things, you know, provides us with different adaptations that, you know, it's that's really, I think, the kind of the mix that you want to create.

SPEAKER_00 29:08

That's uh great uh overview, John, of that of that sort of continuum and the unique and complementary benefits, no matter where one may be on that continuum. Um Yeah, and I, you know, it's uh uh we talked a little bit about these Mets, these metabolic equivalents. And um uh you know, I think that the talk test, the sub, you know, the perception of effort, uh, you know, one doesn't need uh uh sophisticated um equipment uh measuring oxygen consumption and CO2 uh production as a way of getting a sense subjectively of where you might be on that uh continuum. And uh we uh uh and I and I also love just in the examples that you give gave there, John, that um um no matter what we might be doing, uh there are ways to adapt what we're doing to take full advantage of the benefits that each of these levels of activity uh create. And um, you know, I I I love that uh the the telephone poll analogy was was one that resonated with me. That was um many years ago when I started to to just get my life in a into a better place.

unknown 30:36

Yeah.

The UK Biobank Study Setup

SPEAKER_00 30:37

And I you know I've shared this story, but you know, 25 years ago, I was 20 pounds heavier and insulin resistant and hypertensive, and and and oh by the way, I had all the same things that my parents had. So, you know, all my doctors and providers who were really to tremendous people said, oh, it's genetic, you know, this is your the the card you've been dealt, right? And and even today that continues to be sort of the paradigm. And so, you know, if it it it all began to shift when I saw that 10th telephone poll as an invitation to uh really pick it up, right? Almost as if somebody were following me that was a threat. You know, you play these games and and it's amazing how your mind can get you to do things uh that you might otherwise uh never consider. And and so um I love uh how one can use their mind, their you know, imagery, uh narratives that we might we might we might share to ourselves internally. You know, there are many ways that you can begin to coach yourself to, you know, your your um ultimately uh we have all these amazing tools that um uh if they're collecting dust, then uh well they're they're tools that we'll just never use or realize the benefit of. So uh uh just a summary uh as we get into the actual study, John, uh, because the study that we'll look at here uh um uses uh accelerometers. And with all the many devices that are out there today to measure uh um activity, I I thought it would help just to give a quick overview of how an accelerometer might differ than something that's simply measuring steps. And um accelerometers, as we touched on, um really will measure uh movement across all spatial planes, right? We're in this three-dimensional um reality, and and this will measure movement arms, legs, uh, you know, hands, wrists, uh, in those different planes. And you know, the the the amount of data, real-time data, and the extent to which now AI and and more sophisticated algorithms can take that data and uh translate it is is becoming more and more meaningful in terms of the feedback we get. So an accelerometer is really looking at all that raw data and then generating um not just the uh intensity of the exercise, but it it can also measure steps. Uh and so an accelerometer can give you a step count, um, but a something that measures steps only will not be able to give you, as an accelerometer will, the intensity, uh the magnitude of that effort. And and so that's an important distinction, uh, certainly as it relates to the study that will look at. Any any any other thoughts or comments there, John?

SPEAKER_01 33:59

No, I just think it's it's great because again, I I mentioned this earlier. There's I think what's lost in translation is just this concept of movement and the fact that you're needing to consume more oxygen. Um, and it doesn't have to be measured through VO2 max. We know that for every muscle contraction, depending on the intensity, you know, if the cardiopulmonary system can meet that, then you're gonna, you know, you're gonna do that. If you can't, you've crossed what we call the lactic acid threshold, which would be the most extreme, the most intense, um, you know, intense type of exercise. And I just think that it's great that when you talk about these, you know, these different wearables that that are out there, right? Some are gonna just, and and you can you could consider the the stepometer or whatever you call those, right? Those are that's measuring movement, lower body, of course. But now there's just all these different ways to kind of quantify movement. But at the end of the day, regardless of whether someone's wearing a uh a step stepometer, they're wearing a much more advanced wearable that's going to get upper body movement. I think what we're trying to capture here that our listeners can understand is just muscle contraction equals oxygen consumption, right? The faster, the stronger the muscle contractions, the more vigorous that happens in any given time, then the more oxygen is being consumed. And really what we're trying to quantify here is how much oxygen is being demanded of your muscles. And so I love that we get different perspectives on that over the course of this conversation.

SPEAKER_00 35:36

Great.

Big Finding: Intensity Equivalents

SPEAKER_01 35:38

All right. I know, and I and I know, Mark, and we we're not gonna get into it today, but they now have different devices where people, you know, there's things you can breathe into, right? They're gonna measure carbon dioxide to oxygen ratios. There's you know, and they they're they're in wearable form. It's really fascinating where we've gotten in terms of the technology here um to what people are doing with the oxygen they're consuming. It's it's pretty remarkable. Maybe we'll get into that at a later date. Yeah.

SPEAKER_00 36:10

Yeah, yeah. Yeah, I think this that whole right big and exploding topic of biometrics and wearables and uh oxygen consumption. Yeah. Um, so here's the study. Uh this this uh was published um uh earlier this year. Uh and uh um this was from uh I think Nature. Um which is in a great which is a great journal.

SPEAKER_01 36:40

I mean, I it's one of my top three or four.

Why Vigorous Lowers Risk More

SPEAKER_00 36:42

Yeah, yeah. Mine as well. And this is uh right, wearable device-based health equivalents of different physical activity intensities against mortality, cardiometabolic disease, and cancer. So that's a pretty global, yeah, comprehensive uh title there. And uh this slide is an attempt at summarizing uh the study. Um and I do, as I recall, this was open access, so I will I will put and other some other pertinent studies up on our our website. Uh but um again, as we we looked at historically, we've had this historic, you know, this self-reported data where we've suggested that one minute of vigorous activity equates to two minutes of moderate activity. Uh this study challenges that sort of conventional meme. Uh again, looking at accelerometer-derived intensity, and this was the UK Biobank. So this is a large um database of thousands of people in the UK, kind of like our NHANES, at least that's my way of sort of comparing uh here in America. And so 73,458 participants. It was an eight-year follow-up. And so they're all they they had baseline assessments uh using accelerometers. Um they weren't instructed to um, you know, do different uh levels of activity, they just lived their lives. Uh and uh uh as you would expect, there were many that had more regular, vigorous physical activity. Uh many were more sedentary and had just light activity, uh, and then there was that gradient in between of moderate activity. And so they were able to measure that, and then over that eight-year period look at health outcomes. And uh the outcomes that they looked at were all cause mortality, so death from any cause. Then they looked at uh mortality from cardiovascular disease. This is usually a heart attack, cardiac arrest. Uh and then they looked at um chronic complex disease risk, diabetes, cancer, and correlated at the end of this study, what was the what was the correlation? So this was uh you know uh observational study uh of the uh exercise intensity with the likelihood of dying from any cause, dying from a cardiovascular cause, getting diabetes, acquiring cancer, and of course, um at baseline they uh attempted to exclude all those conditions uh so that the assumption is that anything that emerged during this eight year follow up was new for that individual. And um uh so essentially uh they found risk reduction uh regardless of the level of activity, light, moderate, uh vigorous, uh anywhere. From 5% on the low end to as much as 35% on the high end. And again, just by way of summary, one minute of vigorous physical activity was equal to about four minutes of moderate physical activity when it came to all cause mortality risk reduction. So all cause mortality risk was reduced at all levels of activity, mostly seen with higher levels of activity. And again, this just attempted to quantify. If you looked at cardiovascular mortality, one minute of vigorous activity was comparable to about almost eight minutes of that's crazy.

SPEAKER_01 40:56

That's that's unbelievable.

SPEAKER_00 40:58

So that's pretty interesting. And then cancer risk reduction, one minute of vigorous activity was equal to about three and a half minutes of moderate activity. So all these comparisons here were vigorous versus moderate. One minute of vigorous equaled about 53 minutes of light physical activity. In the example of all cause mortality, that's where the benefit was greatest.

Keep Light Movement, Add Bursts

SPEAKER_01 42:33

I think it's profound to think of, you know, especially when you get into the high intensity versus moderate. I think the low intensity is a little easier to appreciate because of you just considered low levels of oxygen demand that are placed with light activities. But you know, to see the one minute of high or vigorous intensity, uh, you know, vigorous exercise to keep it consistent here with the findings and the way things are described, one minute of vigorous exercise equaling eight minutes of moderate exercise for a risk reduction and you know cardiovascular events, and then nine minutes for diabetes. Um, that to me is profound. And I think it speaks, Mark, to the the benefits or the adaptations required uh and how that overlaps with what you need for cardiovascular benefits going forward, right? And and but with the diabetes risk reduction, you know, why are higher intensities so much more protective than moderate? You know, I my mind starts to go in the different directions. That you could are you knocking down glycogen stores and then creating place for dietary carbohydrate to be more safely stored before it just works against the body. That's you know, obviously one area. Or does it have more to do with you know mitochondria densities increasing and then you're better able to, you know, because we know that the mitochondria are involved with so many you know facets of I guess insulin resistance. But it's really remarkable to have that type of ratio one minute to eight minutes or one minute to nine minutes for moderate intensity. It's really it's that's very significant, and especially compared to what you know, I like how you let in with this with the the prior notion where there's always one minute equals two minutes, right? Of moderate. But this really goes beyond challenging it. I'd say that you know, it really blows that out of the water.

SPEAKER_00 44:44

Yeah, I was really uh surprised as well at the magnitude of these uh comparisons. Um I do think uh, and this is just this is the last slide that um is the the data from the study, which I just summarized, uh looking again at all-cause mortality, cardiovascular, these are metabolic, these are cardiac, uh cardiometabolic. Um that's what MACE is essentially referring to uh major adverse cardiac events, and um and again the vigorous to moderate uh, you know, one to four, one to eight, one to five, and and then they add the light, and you can see, you know, you just need much more light activity to get the same adaptive. I I love that the way that you frame that, John, the same adaptive uh benefit that you would with more vigorous and uh I do um um given the magnitude of of change here, I I do think it's important, as we touched on earlier, John, that individuals who might be listening to this thinking, holy cow, I I haven't had vigorous activity in a long time. Uh walking was good for me. Um you know it is. And the answer, the answer we want to be really clear is it is that light activity is is not good for for you. And again, this is a study that looked at mortality. Um these are relative risk reductions. So um is that to say that you uh maybe for all cause mortality, you might not quite realize the same benefit. But is it possible? Just for example, that going out and walking my dog for 30 minutes each day, uh, what's that going to do for my mood, maybe for my depression risk, for uh my pain, for there are many out quality, quality of life that I think improves with any movement.

SPEAKER_01 46:48

I really do.

Progress Safely, Build Sustainability

SPEAKER_00 46:49

Exactly. And so the study wasn't designed to look at those things. I think it's important to just point that out. Um uh that uh there are many, so many attributes of light to moderate physical activity. But uh but I do think that um uh uh particularly as we're all pressed for time, uh anything we can do to diminish the amount of time we have to be committing to the exercise that we're doing, uh looking at strategies to intermittently crank that up if your current state is is complete sedentary states too light, um uh is very much motivated by by these study results. And and the then the last thing I'll say, John, and then I'll stop and let you uh finish for us, uh, is that um uh you know it not everyone is is ready to go from light to vigorous activity. You know, there is a process where one uh if one wants to uh uh go from a predominantly sedentary lifestyle to do it in uh incremental steps. And so you know going from zero to 60 is not um uh uh a safe uh way to be interpreting you know what we're sharing here. One would want to very much um incrementally uh work toward those those ultimate goals. And uh anytime you can be working with a with a uh trainer or uh you know a life coach or or even being with a friend maybe who's who's a bit more advanced than that continuum, um can be very, very helpful. So um this is uh it's the long game that we're talking about here. Uh yeah.

Steady States, Thresholds, Recovery

SPEAKER_01 48:46

And so uh um I yeah, those are just some thoughts. That's well said. That's really well said. I mean, I think that if if someone is just getting into a more regular pattern of exercise and they want to take this information and say, hey, you know, I want to get to some higher intensities. I really appreciate you know what I'm seeing here for the potential benefits and risk reduction. I think starting out, one thing that can be really helpful, and that's what you just said, is allow your body to get into a steady state before you go to the next level of intensity or becomes more vigorous. And that steady state is just a point at which you're asking more of your cardiopulmonary system, you're asking for more oxygen because you're you're moving at a much higher rate than you have, but you do find that after a couple minutes you get back to a place where you can breathe a little more comfortably, right? You don't feel as breathless, then you've reached that steady state, and then you can maybe go to the next level. You can be it can get a little more vigorous. Um, again, just to stay consistent with the terminology here this morning. But you know, that reaching a steady state is um there's a lot of, you know, again, a lot of benefit that takes place when you get there, and then you go to the next level, but just allow your body some time. Not only in the micro time is when you are in about of exercise. Give yourself a couple minutes to adapt to a faster pace before you go even faster again. This might sound like something that's really rudimentary, but a lot of people, to your point, go zero to sixty, right? They cross, they cross the lactic acid threshold, it becomes damn near impossible for them to do that more than a 30-second, one minute, and then they're done. There's soreness, and they it's just a very it's a deterrent to this becoming more of a sustainable way of life. And I think that's what you know I love that you just said is you got to make this sustainable. Um, and I think that allowing yourself some time to adapt, to make those physiological adaptations to the more vigorous, higher intensity exercise, start out with that one telephone pole. Maybe you're gonna get to the point where every 10 telephone poles, you're you're gonna be running two or three. So embrace the discomfort, but don't let that discomfort be so severe or debilitating in that first bout of exercise that it's not something that you uh you go out and look for again. And I think that's it. I mean, right, you gotta have uh you gotta have something you enjoy, you gotta have something that you can do on a regular basis, um, because that's what this study also conveyed, right, Mark? It's that these people, you know, they had whether it was vigorous, whether it was moderate intensity, when you look at any population, and this study would obviously speak to that, where you get that type of risk reduction, it's when it becomes a regular part of your life. And I think, you know, the only way it's going to become a regular part of your life is if it's something that you again, you you you can make it enjoyable. You can let it help you with your outlook on life. It can help you, it can work as an antidepressant, it can, and I think it's, you know, part of it's also what you said, see it as an opportunity. See that discomfort, whether it's for 10 minutes or 30 minutes, whatever that window of time is that it is your breathless and it's uncomfortable. See that as an opportunity, an opportunity for you to grow uh and to adapt in really unique ways that's going to improve your quality of life overall. So great topic. I love talking about exercise, Mark. I mean, we you know, we don't talk about it enough, so when we do, I really appreciate it. And I'm glad you you brought this study to my attention. It's a good one.

SPEAKER_00 52:46

Good stuff, a lot of fun. Yeah, absolutely. John, I really appreciate this. And uh all of our um uh video, audio, uh the the PowerPoint slides uh for those that are interested, and uh some of the articles that we reference that are open source will be uh on our website, the healthedgepodcast.com. Uh John, next week is Christmas week. Um we can connect if you're free. Uh yeah, absolutely. It uh Wednesday will be Christmas Eve. And we we've talked about uric acid, which um that that topic uh as metabolic health goes. And there are some newer, I think, really important insights um to use for folks. So uh let's uh that would be great. That's the papers and talk about that. So, John, always a pleasure, my friend. Same here, buddy. I love you. Love you. So you take care, bro.